Benut Cycling Club

Membership Application Form

Name: .............................................................................................................................................

Date Of Birth: I/C No : Age: ..............

Address: .........................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
................

Post Code: .......................................... Home Tel: .........................................................................

Mobile No: .................................................... email address: .........................................................

ICE (In Case of Emergency) Tel. No. and contact next of kin and relationship

Tel: ......................................................... Name: ...........................................................................

Relationship: ......................................................................................1st Claim Club (If you are
racing for another
club) ................................................................................................................................................
....... Proposed by:

Name: .......................................................... Signature: ..............................................................

Seconded by:Name: ....................................... Signature: ..........................................................

Notes: The completed form should be presented to the club committee at one of the monthly
members. Cheques should be payable to Benut Cycling Club.Subs are due on the 1st January.
Membership will be confirmed following a vote by those full members present at the members
meeting.
BCC Membership Form v1.1 14Jan2017 Page 1

Club activities (e.g. club runs): In the event of an emergency, club members will give as much
assistance as possible but neither the club nor its members undertake any responsibility for
your safety, you must assume full responsibility for your own safety and compliance with the law
of the land relating to road travel.

You must ride in accordance with the BCC Road Discipline and Risk Assessment documents
and follow instructions issued/given by the Ride Leader

Data Protection: Any information provided about you will be kept confidential and secure. It will
only be used for the purpose of contacting you regarding club matters and activities. The club
may take photographs or video footage during club activities. These images could be used by
the club for general publicity purposes and posted on social media.

Safety & Behaviour: It is strongly recommended that a cycling helmet be worn at all
times during cycling activities.You are required to ensure that your bicycle is roadworthy and
legal and has the necessary kit and provisions to take part in the ride, and you are confident in
riding a bicycle.

Any member who persistently misbehaves, including use of abusive or threatening language, or
put others in danger will be asked to leave an activity and will not be allowed to continue. In this
event the club reserves the right to terminate their membership with immediate effect.

Medical Information: You are required to declare to the Ride Leader any medical conditions
you feel may affect your ability to cycle (e.g. Asthma):

I confirm I have read and understand and will comply with the DCC Road Discipline, the Generic
Risk Assessment and the DCC Safeguarding Policy documents, all of which can be located on
the club website as below.

I also accept that Benut Cycling Club cannot be held responsible for any personal injury,
accident or public liability during the cycle ride or any event held by Benut Cycling Club.

Name: (print)...............................................................................................................................

Signature: ..................................................................................................................................

Date: ........................................................................

PLEASE PRESENT THE COMPLETED FORM TO THE CLUB MEMBERSHIP SECRETARY

OR COMMITTEE AT THE NEXT MONTHLY MEMBERS MEETING